Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Lydia Forsythe

Second Advisor

Dr. Melanie Brewer

Third Advisor

Dr. Corinne Cochran

Abstract

  • Problem: The target hospital faced serious throughput challenges, with emergency department overcrowding and discharge inefficiencies impacting patient outcomes and organizational performance. Discharge order to depart times exceeded the 90-minute benchmark, averaging 154 minutes, while 41.2% of patients exceeded the geometric mean length of stay (GMLOS) target of 40.17%. Gaps included inconsistent discharge planning, poor communication, and limited follow-through on barriers.
  • Aim of the Project: The project aimed to improve hospital throughput by reducing GMLOS and discharge order to depart times on Unit A. This was achieved through implementation of proactive, evidence-based interventions to streamline discharges, reduce delays, and support safe patient transitions.
  • Review of Evidence: A literature review supported interventions like focused flash rounds and the Readiness for Hospital Discharge Scale (RHDS) assessment to enhance discharge planning, reduce GMLOS, and improve team communication. Evidence highlighted proactive, patient-centered approaches as essential for improving care coordination and system efficiency.
  • Project Design: Guided by the Plan-Do-Study-Act (PDSA) cycle and OhioHealth Change Management model, the project employed continuous feedback, stakeholder engagement, and iterative adjustments. Weekly check-ins, change readiness assessments, and electronic medical record (EMR) based communication ensured real-time problem-solving and alignment.
  • Intervention: The intervention included daily EMR secure-chat flash rounds and RHDS assessments for patients with a disposition to home. These tools identified readiness gaps early and triggered targeted actions including PT/OT or care management consults, improving discharge preparedness.
  • Significant Findings/Outcomes: Discharge order to depart time improved by 32 minutes, from 175 to 143. RHDS assessment completion reached 96%, with 84% compliance for flash rounds. Although GMLOS improvement was minimal, 0.03%, results indicated process adoption and stakeholder support for sustainability.
  • Implications for Nursing: This initiative emphasized nursing’s role in proactive discharge planning and interdisciplinary communication. It enhanced patient-centered care, reduced risks from prolonged hospitalization, and demonstrated potential for system-wide adoption. Ongoing nursing leadership and integration into EMR workflows are key to long-term impact and cost savings.

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